Browsing the blog archivesfor the day Tuesday, May 5th, 2009.


Zombie Bank

Financial Crisis
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What Is the Purpose of a Health Care System?

Health Care

This is something of a follow up to “Why Is There an Economy?” The Center for American Progress has an alarming report on the number of Americans losing their health insurance every day. The rate of uninsured Americans is growing in every state, and most of the uninsured have jobs.

Matt Yglesias comments,

Right now, a person who develops a serious medical problem can continue to enjoy health insurance coverage if and only if he or she is able to maintain health insurance continuously. But if you lose your insurance because you get laid off, and then can’t find a new job for a while because of generally bad labor market conditions, then even though you’ll be able to get a new job when the economy revives, you’ll now find that your illness means you can’t get coverage for your medical problem. That’s totally rational business practice, but it completely defeats the purpose of a health care system which is precisely to ensure that sick people can get health care.

If you pay close attention to right-wing arguments against national health care, you notice the underlying assumption: The purpose of a health care system is to support a profitable health care industry. For example, regulations that mandate insurance companies insure people with pre-existing conditions are bad, because they are bad for business.

On the other hand, if your underlying assumption is that the purpose of a health care system is to provide health care to people who need it, you must be a liberal.

I did a news google looking for a right-wing argument against national health care, and this is the first one that came up. It’s not as strident as many. It does begin with the straw-man assumption that people who want a national health care system expect it to be free. I have never met anyone who thought that.

The author also falls back on the assumption that “government bureaucracies” always are more expensive and inefficient than private enterprise. But the American health care “system” already is the most inefficient on the planet. We spend much more on health care per capita than any other nation and get poorer results.

In any event, the argument that government bureaucracies always are more inefficient than private enterprise simply is not supported by facts. Any large organization, whether a business or a government, can be run well or poorly. It’s true that consumer products companies work at being cost effective in order to survive. But notice a lot of them aren’t exactly surviving these days.

And as I’ve pointed out elsewhere, the laws of supply and demand do not apply to health care in the same way that they apply to mp3 players. People don’t shop for health care in the same way they shop for toasters. If you want to buy a toaster, you go to a retail store and pick out the nicest one you can afford. This provides an incentive to toaster manufacturers to make better toasters that cost less. However, with health care, it’s more like you buy a membership in the retail store — your health insurer — and the store decides what toaster you can have, and even whether you will get a toaster at all.

The author of the anti-national health care article writes,

Advocates of national health insurance argue that preventive care is cheaper than trying to care for patients who have become seriously ill. This is true, but preventive care is more expensive than no care – which is what uninsured people usually choose. If we adopt universal health insurance, people who normally do not go to the doctor will go, and some one will have to pay for that care.

Kind of stunning, yes?

Social security insurance and Medicare have worked to provide more money and better health care for the elderly. But as a consequence old people live longer, collect more social security, and need more Medicare. Both programs have become vastly more expensive than was originally projected.

See, if we could just let more people die younger, it wouldn’t be such a strain on the system.

The author then brings up the awful specter of rationing health care, without noticing we are already rationing health care — if you don’t have insurance, you don’t get health care.

The author is correct that one reason health care is more expensive than it was many years ago is that medical science has developed new technologies and therapies that are excellent, but expensive. A century ago, if you broke your leg, the doctor would diagnose this by feeling your leg. Then we went to X-rays. Now there are MRIs. Very expensive stuff. But for that very reason, the old system of letting people pay the doctor however they could doesn’t work any more. And the more recent system of providing health insurance through employment is breaking down, also.

The author doesn’t bring up right-wing arguments against so incremental a step as a public insurance program that might compete with private insurance. Such a public program might be able to provide lower cost insurance by widely pooling risk and through subsidies. And that’s not fair to private insurance companies. See, it’s better to let millions of Americans go without decent health care than to not be fair to private insurance companies. As I said, to the Right, the purpose of a health care system is to support a profitable health care industry.

There’s nothing wrong with profits, and those nations that have the best health care systems as measured by cost per capita and results tend to have mixed public and private systems. It’s not just the government pulling the whole load; there is still a place for private enterprise. But those nations with the most cost-effective health care systems have the crazy idea that the purpose of a health care system is to provide health care. Radical.

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